The cutting edge of medicine: an update from recent conferences (Proceedings)
Abstracts from the VECCS Conference, San Antonio, 2010
Complications from treatment of IMHA.
Immune suppression is the cornerstone of the treatment of IMHA. Commonly used medications include corticosteroids, azathioprine, and cyclosporine. Side effects can occur because of the medication used or could be from the immune suppression itself. To date there is little data on the incidence of side effects in dogs treated for IMHA. Researchers from Michigan State University carried out a retrospective study to assess the incidence of complications. A total of 57 dogs were included (had to have had IMHA and survived for 1 month) seen between 2004 and 2007. A total of 94% of dogs experienced complications. GI side effects were seen in 51% of patients and included 23% with vomiting, 35% with diarrhea, 12% with hematochezia, and 11% with anorexia. Pancreatitis was suspected in 9% of the dogs. Urinary problems were seen in 49% of patients (28% PU/PD, 26% UTI, 14% inappropriate urination). Dermatologic problems were seen in almost half the dogs as well (alopecia, dry skin, fungal infections, abscess, ear infections, demodex). Some of these are probably directly attributable to the medications (corticosteroids causing skin issues and PU/PD), others such as the GI signs may also be from the primary disorder or stress of hospitalization. Overall complications are common, though few seem to be severe in nature with the exception of pancreatitis.Backstrom MM, Jutkowitz JA, et al. Complications associated with long-term immunosuppressive therapy in dog with immune-mediated hemolytic anemia. JVECCS, volume 20, supplement 1, page A8.
27 th Annual ACVIM Forum, Montreal
Hypertension in hyperthyroid cats
The exact incidence of hypertension in hyperthyroid cats is unknown to date. Certainly some cats with hyperthyroidism do appear to develop clinically significant hypertension. This study from the UK looked at 324 cats presented to a first opinion practice (21 were excluded since they were being treated for hyptension). Hypertension was considered a BP greater than 170 mmHg (using Doppler) if repeatable or if appropriate ocular signs were present. Of the 303 cats tested 12.9% were diagnosed with hypertension. Interestingly over 22% became hypertensive after their hyperthyroidism was treated (between 3 and 9 months after starting therapy). Renal status was not associated with the risk of hypertension. This study does suggest that blood pressure should be checked when hyperthyroidism is diagnosed and routinely during treatment.
Morrow LD et al. Hypertension in hyperthyroid cats; prevalence, incidence and predictors of its development. JVIM 23; 699: 2009
26 th Annual ACVIM Forum San Antonio
Pimobendan and therapy of pulmonary hypertension
Pimobendan has shown some benefit in treating pulmonary hypertension (PHT) in humans. PHT is a difficult disease to treat and prognosis is usually poor in dogs. The use of sildenafil has been investigated for the treatment of PHT and may be of benefit. This study involved 10 dogs diagnosed with PHT. These dogs showed clinical signs such as cough, right sided heart failure or syncope. The patients were followed for 91 days with echocardiography and quality of life scores. The patients were given either pimobendan or a placebo for 14 days after which they were switched to the other treatment. After this all dogs received pimobendan for 8 weeks. Pimobendan significantly decreased echo parameters of PHT in the short term. Quality of life also improved. Unfortunately only the effect on echo parameters was maintained at 90 days, quality of life was not changed. This may be from the small number of dogs or more likely that PHT is a progressive disease with poor prognosis. Certainly pimobendan is a viable option for treating PHT in dogs though the prognosis still remains poor though a short-term positive effect can be expected.
Atkinson KJ et al. Evaluation of pimobendan for the therapy of canine pulmonary hypertension. JVIM 22; 761-2: 2008.
Multi Drug Resistant E. coli following enrofloxacin therapy
There is always concern that antibiotic administration can lead to resistant bacteria. Multidrug resistant bacteria (MDR) are of great concern to the patient, owner and clinic. In this study groups of 8 dogs were given either enrofloxacin, amoxicillin or no antibiotic. Dogs were studied for at least 7 days or up to 21 days. The medications were stopped once resistance developed (> 75% of CFU resistant). The dogs were then followed for up to 4 weeks or when < 25% of the CFU were resistant. None of the dogs had any resistance at the beginning. Resistance to amoxicillin developed in the amoxicillin and enrofloxacin treated groups. Enrofloxacin resistance was only encountered in those dogs treated with enrofloxoacin (half the dogs). All isolates that developed enrofloxacin resistance were all also MDR. Amoxicillin resistance disappeared rapidly, whereas enrofloxacin resistance was more persistent.
Debavalya N, Boothe DM, Hathcock T. Multidrug resistance in fecal Escherichia coli following routine enrofloxacin but not amoxicillin therapy in dogs. JVIM 22; 786: 2008.